Highlights
- •Patients with upper limb post-stroke spasticity were treated with botulinum toxin.
- •Central effects of spasticity treatment were studied using functional MRI.
- •Brain activation pattern was assessed during passive hand movements.
- •BoNT-induced spasticity relief is associated with changes in sensorimotor network.
Abstract
Introduction
In post-stroke spasticity, functional imaging may uncover modulation in the central
sensorimotor networks associated with botulinum toxin type A (BoNT) therapy. Investigations
were performed to localize brain activation changes in stroke patients treated with
BoNT for upper limb spasticity using functional magnetic resonance imaging (fMRI).
Methods
Seven ischemic stroke patients (4 females; mean age 58.86) with severe hand paralysis
and notable spasticity were studied. Spasticity was scored according to the modified
Ashworth scale (MAS). fMRI examination was performed 3 times: before (W0) and 4 (W4)
and 11 weeks (W11) after BoNT. The whole-brain fMRI data were acquired during paced repetitive
passive movements of the plegic hand (flexion/extension at the wrist) alternating
with rest. Voxel-by-voxel statistical analysis using the General Linear Model (GLM)
implemented in FSL (v6.00)/FEAT yielded group session-wise statistical maps and paired
between-session contrasts, thresholded at the corrected cluster-wise significance
level of p < 0.05.
Results
As expected, BoNT transiently lowered MAS scores at W4. Across all the sessions, fMRI
activation of the ipsilesional sensorimotor cortex (M1, S1, and SMA) dominated. At
W4, additional clusters transiently emerged bilaterally in the cerebellum, in the
contralesional sensorimotor cortex, and in the contralesional occipital cortex. Paired
contrasts demonstrated significant differences W4 > W0 (bilateral cerebellum and contralesional occipital cortex) and W4 > W11 (ipsilesional cerebellum and SMA). The remaining paired contrast (W0 > W11) showed activation decreases mainly in the ipsilesional sensorimotor cortex (M1,
S1, and SMA).
Conclusions
The present study confirms the feasibility of using passive hand movements to map
the cerebral sensorimotor networks in patients with post-stroke arm spasticity and
demonstrates that BoNT-induced spasticity relief is associated with changes in task-induced
central sensorimotor activation, likely mediated by an altered afferent drive from
the spasticity-affected muscles.
Keywords
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Article Info
Publication History
Published online: January 11, 2016
Accepted:
December 31,
2015
Received in revised form:
December 8,
2015
Received:
October 25,
2015
Identification
Copyright
© 2016 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
